ROUTINE RECOVERY
The clinical outcomes that follow surgery and anesthesia are what
the patient is likely to remember. Some facilities require a minimal period of PACU
observation after all surgical procedures. However, some patients may meet discharge
criteria on arrival at the recovery room. Instead of requiring a minimum PACU stay
for all patients, PACU stay can be adjusted according to patient and surgical factors—sicker
patients undergoing extensive surgery will require extended recovery.
Awakening after Inhaled Anesthetics
The time to recovery from inhaled anesthetics is a function of
both the solubility coefficient of the drug and the level of alveolar ventilation
of the patient (also see Chapter 5
).
[25]
Desflurane versus Isoflurane and Propofol
A meta-analysis of the international, peer-reviewed, published
literature found that when the end-tidal minimum alveolar concentration was kept
constant, patients who received desflurane followed commands 5 minutes earlier than
did patients who received isoflurane.[26]
This
study also found no statistically significant difference in time to following commands
between desflurane and propofol. However, patients who received propofol for induction
and maintenance were discharged home approximately a quarter of an hour more quickly
than the patients who received desflurane ( Table
71-2
).
Sevoflurane versus Isoflurane or Propofol
One study demonstrated a significantly faster time to eye opening
with sevoflurane than with isoflurane.[38]
However,
patients receiving sevoflurane were not ready
for discharge home any faster than patients receiving isoflurane. When compared
with propofol-based anesthesia, sevoflurane-treated patients had more rapid eye opening
and were extubated sooner in one study,[39]
but
not in another.[40]
Sevoflurane versus Desflurane
The results of five studies comparing time to following commands
for desflurane and sevoflurane are presented in Table
71-3
.
